Provider Demographics
NPI:1902592751
Name:CARDOZA, KATHLEEN WEBB (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:WEBB
Last Name:CARDOZA
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 STEPHANIE ST
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-3553
Mailing Address - Country:US
Mailing Address - Phone:704-763-1522
Mailing Address - Fax:
Practice Address - Street 1:170 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-2766
Practice Address - Country:US
Practice Address - Phone:615-802-8051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-14
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7554225XP0200X
7554225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics